Background Burn injuries are a major public health concern and in the US alone, making up about 500,000 ED visits per year. While most of these burn injuries are minor, the ones that do require hospital admission are often directed towards specialized burn centers. These burn centers, which provide optimal burn care, involve a team of healthcare workers from many different specialties including highly trained burn surgeons along with other rehabilitation services. EMS official guidelines concerning pre-hospital management of burn patients state that patients should be transported to either the nearest emergency department, or if protocols allow, directly to a burn center. With the emergence of more specialized burn centers, pre-hospital providers must triage their patients to an appropriate destination. And despite the prevalence of burns, less than 1% of all EMS calls from 2020-2023 in North Carolina were burn related. Such a low occurrence means that pre-hospital providers have minimal experience with this population of patients. The pre-hospital transport destination, burn center or local hospital, depends on the burn classification. Burn classifications are highly dependent on the clinical examination, which is subjective especially for providers without specialty training in burns. Methods In this retrospective study, all emergency response calls categorized as burn-related were analyzed using the NC Continuum Database from 2020-2023. A total of 3467 transports were evaluated. Based on the chief complaint, the determination was made, according to the American Burn Association and UNC Jaycee Burn Center criteria, whether the patient should have been transferred to a burn center, or local hospital. If there was not enough data to determine this information, the record was categorized as unknown. Results Of the patients we determined as needing specialized care from a burn center (n=246), 68% were not transported appropriately, while only 32% were. Of the patients who we determined that local hospital care was appropriate (n=111), 14% were transported inappropriately to a burn center. Less than 2% of charts reported percentage of total body surface area (TBSA) of burn within the chief complaint. We classified 2868 number of transports as “unknown” due to lack of fully descriptive criteria that would allow us to correctly categorize the transport decision. Conclusion The lack of appropriate triage and destination for burn patients can negatively impact patient outcomes. This highlights the need for a standardized approach to pre-hospital burn management which can be facilitated by further education of EMS providers.